9 research outputs found
Nighttime assaults: using a national emergency department monitoring system to predict occurrence, target prevention and plan services
Background: Emergency department (ED) data have the potential to provide critical intelligence on when violence
is most likely to occur and the characteristics of those who suffer the greatest health impacts. We use a national
experimental ED monitoring system to examine how it could target violence prevention interventions towards at
risk communities and optimise acute responses to calendar, holiday and other celebration-related changes in
nighttime assaults.
Methods: A cross-sectional examination of nighttime assault presentations (6.01 pm to 6.00 am; n = 330,172) over a
three-year period (31st March 2008 to 30th March 2011) to English EDs analysing changes by weekday, month,
holidays, major sporting events, and demographics of those presenting.
Results: Males are at greater risk of assault presentation (adjusted odds ratio [AOR] 3.14, 95% confidence intervals
[CIs] 3.11-3.16; P < 0.001); with male:female ratios increasing on more violent nights. Risks peak at age 18 years. Deprived individuals have greater risks of presenting across all ages (AOR 3.87, 95% CIs 3.82-3.92; P < 0.001). Proportions of assaults from deprived communities increase midweek. Female presentations in affluent areas peak aged 20 years. By age 13, females from deprived communities exceed this peak. Presentations peak on Friday and Saturday nights and the eves of public holidays; the largest peak is on New Year’s Eve. Assaults increase over
summer with a nadir in January. Impacts of annual celebrations without holidays vary. Some (Halloween, Guy
Fawkes and St Patrick’s nights) see increased assaults while others (St George’s and Valentine’s Day nights) do not. Home nation World Cup football matches are associated with nearly a three times increase in midweek assault
presentation. Other football and rugby events examined show no impact. The 2008 Olympics saw assaults fall. The
overall calendar model strongly predicts observed presentations (R2 = 0.918; P < 0.001).
Conclusions: To date, the role of ED data has focused on helping target nightlife police activity. Its utility is much greater; capable of targeting and evaluating multi-agency life course approaches to violence prevention and
optimising frontline resources. National ED data are critical for fully engaging health services in the prevention of violence
Clinical manifestations and outcome in Staphylococcus aureus endocarditis among injection drug users and nonaddicts: a prospective study of 74 patients
BACKGROUND: Endocarditis is a common complication in Staphylococcus aureus bacteremia (SAB). We compared risk factors, clinical manifestations, and outcome in a large, prospective cohort of patients with S. aureus endocarditis in injection drug users (IDUs) and in nonaddicts. METHODS: Four hundred and thirty consecutive adult patients with SAB were prospectively followed up for 3 months. Definite or possible endocarditis by modified Duke criteria was found in 74 patients: 20 patients were IDUs and 54 nonaddicts. RESULTS: Endocarditis was more common in SAB among drug abusers (46%) than in nonaddicts (14%) (odds ratio [OR], 5.12; 95% confidence interval [CI], 2.65–9.91; P < 0.001). IDUs were significantly younger (27 ± 15 vs 65 ± 15 years, P < 0.001), had less ultimately or rapidly fatal underlying diseases (0% vs 37%, P < 0.001) or predisposing heart diseases (20% vs 50%, P = 0.03), and their SAB was more often community-acquired (95% vs 39%, P < 0.001). Right-sided endocarditis was observed in 60% of IDUs whereas 93% of nonaddicts had left-sided involvement (P < 0.001). An extracardiac deep infection was found in 85% of IDUs and in 89% of nonaddicts (P = 0.70). Arterial thromboembolic events and severe sepsis were also equally common in both groups. There was no difference in mortality between the groups at 7 days, but at 3 months it was lower among IDUs (10%) compared with nonaddicts (39%) (OR, 5.73; 95% CI, 1.20–27.25; P = 0.02). CONCLUSION: S. aureus endocarditis in IDUs was associated with as high complication rates including extracardiac deep infections, thromboembolic events, or severe sepsis as in nonaddicts. Injection drug abuse in accordance with younger age and lack of underlying diseases were associated with lower mortality, but after adjusting by age and underlying diseases injection drug abuse was not significantly associated with mortality
The establishment of injury surveillance systems in Colombia, El Salvador, and Nicaragua (2000-2006) Establecimiento de sistemas de vigilancia de lesiones en Colombia, El Salvador y Nicaragua (2000-2006)
<abstract language="spa">La Organización Panamericana de la Salud (OPS), en colaboración con los Centros para el Control y la Prevención de Enfermedades (CDC) de los Estados Unidos de América, estableció en 2000 sistemas para la vigilancia de lesiones en Colombia, El Salvador y Nicaragua. Estos sistemas, basados en los servicios hospitalarios de emergencia, formaron parte de un proyecto piloto fundamentado en las guÃas para la vigilancia de lesiones, desarrolladas por la Organización Mundial de la Salud (OMS) y los CDC. Los objetivos de este proyecto eran evaluar la utilidad de las guÃas de la OMS/CDC, crear mecanismos apropiados para la vigilancia de lesiones en los tres paÃses, promover intervenciones preventivas adecuadas e integrar la prevención y el control de lesiones en proyectos nacionales de salud pública. En este artÃculo se describe el proyecto piloto de la OPS/CDC y se resaltan los principios más importantes y las lecciones aprendidas durante sus seis años de funcionamiento (2000-2006). Entre las principales recomendaciones se encuentran la integración de la vigilancia de las lesiones en las unidades de epidemiologÃa e información existentes en los ministerios de salud, la recogida de los datos importantes exclusivamente, la garantÃa de monitoreos y evaluaciones adecuados y la adopción de las prácticas que han demostrado ser más efectivas para el entrenamiento de personal y la diseminación de información